1
|
Zeng H, Zeng D, Yin X, Zhang W, Wu M, Chen Z. Research progress on high-concentration oxygen therapy after cerebral hemorrhage. Front Neurol 2024; 15:1410525. [PMID: 39139771 PMCID: PMC11320605 DOI: 10.3389/fneur.2024.1410525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
Recently, the role of high-concentration oxygen therapy in cerebral hemorrhage has been extensively discussed. This review describes the research progress in high-concentration oxygen therapy after cerebral hemorrhage. High-concentration oxygen therapy can be classified into two treatment methods: hyperbaric and normobaric high-concentration oxygen therapy. Several studies have reported that high-concentration oxygen therapy uses the pathological mechanisms of secondary ischemia and hypoxia after cerebral hemorrhage as an entry point to improve cerebral oxygenation, metabolic rate, cerebral edema, intracranial pressure, and oxidative stress. We also elucidate the mechanisms by which molecules such as Hypoxia-inducible factor 1-alpha (HIF-1α), vascular endothelial growth factor, and erythropoietin (EPO) may play a role in oxygen therapy. Although people are concerned about the toxicity of hyperoxia, combined with relevant literature, the evidence discussed in this article suggests that as long as the duration, concentration, pressure, and treatment interval of patients with cerebral hemorrhage are properly understood and oxygen is administered within the treatment window, it can be effective to avoid hyperoxic oxygen toxicity. Combined with the latest research, we believe that high-concentration oxygen therapy plays an important positive role in injuries and outcomes after cerebral hemorrhage, and we recommend expanding the use of normal-pressure high-concentration oxygen therapy for cerebral hemorrhage.
Collapse
Affiliation(s)
- He Zeng
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, Jiangxi, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China
| | - Dakai Zeng
- Department of Anorectal Surgery, Third Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xiaoping Yin
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, Jiangxi, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China
| | - Wumiao Zhang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, Jiangxi, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China
| | - Moxin Wu
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China
| | - Zhiying Chen
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, Jiangxi, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China
| |
Collapse
|
2
|
Chiang MK, Lin TC, Lin KH, Chang YC, Hsieh-Li HM, Lai DM. Hyperbaric Oxygen Therapy Attenuated the Motor Coordination and Cognitive Impairment of Polyglutamine Spinocerebellar Ataxia SCA17 Mice. CEREBELLUM (LONDON, ENGLAND) 2024; 23:401-417. [PMID: 36943575 DOI: 10.1007/s12311-023-01548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a large and diverse group of autosomal-dominant neurodegenerative diseases. No drugs have been approved for these relentlessly progressive and fatal SCAs. Our previous studies indicate that oxidative stress, neuroinflammation, and neuronal apoptosis are elevated in the SCA17 mice, which are the main therapeutic targets of hyperbaric oxygen treatment (HBOT). HBOT is considered to be an alternative and less invasive therapy for SCAs. In this study, we evaluated the HBOT (2.2 ATA for 14 days) effect and the persistence for the management of SCA17 mice and their wild-type littermates. We found HBOT attenuated the motor coordination and cognitive impairment of SCA17 mice and which persisted for about 1 month after the treatment. The results of several biochemistry and liver/kidney hematoxylin and eosin staining show the HBOT condition has no obvious toxicity in the mice. Immunostaining analyses show that the neuroprotective effect of HBOT could be through the promotion of BDNF production and the amelioration of neuroinflammation. Surprisingly, HBOT executes different effects on the male and female SCA17 mice, including the reduction of neuroinflammation and activation of CaMKII and ERK. This study suggests HBOT is a potential alternative therapeutic treatment for SCA17. Accumulated findings have revealed the similarity in disease pathomechanisms and possible therapeutic strategies in polyQ diseases; therefore, HBOT could be an optional treatment as well as the other polyQ diseases.
Collapse
Affiliation(s)
- Meng-Ke Chiang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Ta-Chun Lin
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | | | - Ya-Chin Chang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Hsiu Mei Hsieh-Li
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
3
|
Shi R, Meng W, Liu Z, Chang L, Lu R, Chen X, Xue W, Deng Y. Hyperbaric oxygen therapy for poststroke insomnia: a systematic review and meta-analysis protocol. BMJ Open 2024; 14:e081642. [PMID: 38553058 PMCID: PMC10982781 DOI: 10.1136/bmjopen-2023-081642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Insomnia stands as a frequent consequence of a cerebrovascular event, afflicting a substantial fraction of those who endure the aftermath of stroke. The ramifications of insomnia following a stroke can further exacerbate cognitive and behavioural anomalies while hindering the process of neurological convalescence. While several randomised controlled trials (RCTs) have scrutinised the effects of hyperbaric oxygen therapy (HBOT) on poststroke insomnia, the advantages and drawbacks persist in a state of ambiguity. We advocate for a systematic review and meta-analysis of randomised clinical trials to comprehensively evaluate the effectiveness and safety of HBOT in the context of poststroke insomnia. METHODS AND ANALYSIS A systematic search will be conducted from nine major databases (PubMed, Web of Science, EMBASE, VIP Information Database, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, China Biomedical Literature Database and Wanfang Database, Physiotherapy Evidence Database (PEDro)) for HBOT for poststroke insomnia of RCTs. The search procedures will adhere to a rigorous approach, commencing from the inception date of each database and continuing until 1 November 2023, with inquiries conducted exclusively in English and Chinese. The primary outcome will focus on the alteration in the quality of sleep while secondary outcomes will encompass the evaluation of adverse events and the rate of reoccurrence. The process of selecting studies, extracting data and evaluating the quality of research will be carried out independently by two reviewers. The quality of the included literature will be assessed using the tools of the Cochrane Collaboration. Meta-analysis will be performed by using RevMan V.5.4 and STATA V.16.0.b software. Finally, the quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation method. ETHICS AND DISSEMINATION As all data are derived from published investigations via databases without direct patient contact, ethical approval is obviated in this study. The scientific studies will be published in professional academic publications. PROSPERO REGISTRATION NUMBER CRD42023468442.
Collapse
Affiliation(s)
- Rui Shi
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Wenyi Meng
- Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhaozheng Liu
- Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Liping Chang
- Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Ruozhu Lu
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xingyu Chen
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Wen Xue
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yue Deng
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| |
Collapse
|
4
|
Schimmel S, El Sayed B, Lockard G, Gordon J, Young I, D’Egidio F, Lee JY, Rodriguez T, Borlongan CV. Identifying the Target Traumatic Brain Injury Population for Hyperbaric Oxygen Therapy. Int J Mol Sci 2023; 24:14612. [PMID: 37834059 PMCID: PMC10572450 DOI: 10.3390/ijms241914612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Traumatic brain injury (TBI) results from direct penetrating and indirect non-penetrating forces that alters brain functions, affecting millions of individuals annually. Primary injury following TBI is exacerbated by secondary brain injury; foremost is the deleterious inflammatory response. One therapeutic intervention being increasingly explored for TBI is hyperbaric oxygen therapy (HBOT), which is already approved clinically for treating open wounds. HBOT consists of 100% oxygen administration, usually between 1.5 and 3 atm and has been found to increase brain oxygenation levels after hypoxia in addition to decreasing levels of inflammation, apoptosis, intracranial pressure, and edema, reducing subsequent secondary injury. The following review examines recent preclinical and clinical studies on HBOT in the context of TBI with a focus on contributing mechanisms and clinical potential. Several preclinical studies have identified pathways, such as TLR4/NF-kB, that are affected by HBOT and contribute to its therapeutic effect. Thus far, the mechanisms mediating HBOT treatment have yet to be fully elucidated and are of interest to researchers. Nonetheless, multiple clinical studies presented in this review have examined the safety of HBOT and demonstrated the improved neurological function of TBI patients after HBOT, deeming it a promising avenue for treatment.
Collapse
Affiliation(s)
- Samantha Schimmel
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Bassel El Sayed
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Gavin Lockard
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Jonah Gordon
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | | | - Francesco D’Egidio
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
| | - Jea Young Lee
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
| | - Thomas Rodriguez
- School of Medicine, Loma Linda University, 11175 Campus St., Loma Linda, CA 92350, USA;
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
| |
Collapse
|
5
|
Ablin JN, Lang E, Catalogna M, Aloush V, Hadanny A, Doenyas-Barak K, Finci S, Polak N, Fishlev G, Korin C, Tzidky RY, Meir Genuth O, Efrati S. Hyperbaric oxygen therapy compared to pharmacological intervention in fibromyalgia patients following traumatic brain injury: A randomized, controlled trial. PLoS One 2023; 18:e0282406. [PMID: 36897850 PMCID: PMC10004612 DOI: 10.1371/journal.pone.0282406] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/08/2023] [Indexed: 03/11/2023] Open
Abstract
Fibromyalgia is a chronic pain syndrome with unsatisfactory response to current treatments. Physical trauma, including traumatic brain Injury (TBI) is among the etiological triggers. Hyperbaric Oxygen therapy (HBOT) is an intervention that combines 100% oxygen with elevated atmospheric pressure. HBOT has been applied as a neuro-modulatory treatment in central nervous system-related conditions. The current study investigated the utility of HBOT for TBI-related fibromyalgia. Fibromyalgia patients with a history of TBI were randomized to either HBOT or pharmacological intervention. HBOT protocol comprised 60 daily sessions, breathing 100% oxygen by mask at 2 absolute atmospheres (ATA) for 90 minutes. Pharmacological treatment included Pregabalin or Duloxetine. The primary outcome was subjective pain intensity on visual analogue scale (VAS); Secondary endpoints included questionnaires assessing fibromyalgia symptoms as well as Tc-99m-ECD SPECT brain imaging. Pain threshold and conditioned pain modulation (CPM) were also assessed. Results demonstrated a significant group-by-time interaction in pain intensity post-HBOT compared to the medication group (p = 0.001), with a large net effect size (d = -0.95) in pain intensity reduction following HBOT compared to medications. Fibromyalgia related symptoms and pain questionnaires demonstrated significant improvements induced by HBOT as well as improvements in quality of life and increase in pain thresholds and CPM. SPECT demonstrated significant group-by-time interactions between HBOT and medication groups in the left frontal and the right temporal cortex. In conclusion, HBOT can improve pain symptoms, quality of life, emotional and social function of patients suffering from FMS triggered by TBI. The beneficial clinical effect is correlated with increased brain activity in frontal and parietal regions, associated with executive function and emotional processing.
Collapse
Affiliation(s)
- Jacob N. Ablin
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- * E-mail:
| | - Erez Lang
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Valerie Aloush
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
| | - Amir Hadanny
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Keren Doenyas-Barak
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Shachar Finci
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Nir Polak
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Gregory Fishlev
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Calanit Korin
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Rachel Yehudit Tzidky
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Oshra Meir Genuth
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Shai Efrati
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
6
|
Yan Y, Zhang X, An X, Fan W, Liang J, Luo B, Ren H, Huang Y. The application and perspective of hyperbaric oxygen therapy in acute ischemic stroke: From the bench to a starter? Front Neurol 2022; 13:928802. [PMID: 35989933 PMCID: PMC9389005 DOI: 10.3389/fneur.2022.928802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke has become a significant cause of death and disability globally. Along with the transition of the world's aging population, the incidence of acute ischemic stroke is increasing year by year. Even with effective treatment modalities, patients are not guaranteed to have a good prognosis. The treatment model combining intravenous thrombolysis/endovascular therapy and neuroprotection is gradually being recognized. After the clinical translation of pharmacological neuroprotective agents failed, non-pharmacological physical neuroprotective agents have rekindled hope. We performed a literature review using the National Center for Biotechnology Information (NCBI) PubMed database for studies that focused on the application of hyperbaric oxygen therapy in acute ischemic stroke. In this review, we present the history and mechanisms of hyperbaric oxygen therapy, focusing on the current status, outcomes, current challenges, perspective, safety, and complications of the application of hyperbaric oxygen in animal experiments and human clinical trials. Hyperbaric oxygen therapy, a non-pharmacological treatment, can improve the oxygenation level at the ischemic lesions in increased dissolved oxygen and oxygen diffusion radius to achieve salvage of neurological function, giving a new meaning to acute ischemic stroke.
Collapse
Affiliation(s)
- Yujia Yan
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiqiang Zhang
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Xingwei An
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Tianjin Center for Brain Science, Tianjin, China
| | - Wanpeng Fan
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Jingbo Liang
- Department of Neurosurgery, Third People's Hospital of Xining City, Xining, China
| | - Bin Luo
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Hecheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- *Correspondence: Hecheng Ren
| | - Ying Huang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- Ying Huang
| |
Collapse
|
7
|
Balasubramanian P, Delfavero J, Nyul-Toth A, Tarantini A, Gulej R, Tarantini S. Integrative Role of Hyperbaric Oxygen Therapy on Healthspan, Age-Related Vascular Cognitive Impairment, and Dementia. FRONTIERS IN AGING 2021; 2:678543. [PMID: 35821996 PMCID: PMC9261405 DOI: 10.3389/fragi.2021.678543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/09/2021] [Indexed: 12/17/2022]
Abstract
Growing life expectancy will contribute to the on-going shift towards a world population increasingly comprised of elderly individuals. This demographic shift is associated with a rising prevalence of age-related diseases, among all age-related pathologies it has become crucial to understand the age-associated cognitive changes that remain a major risk factor for the development of vascular cognitive impairment and dementia (VCID). Furthermore, age-related Alzheimer's disease and other neurogenerative diseases with vascular etiology are the most prominent contributing factors for the loss of cognitive function observed in aging. Hyperbaric Oxygen Therapy (HBOT) achieves physiologic effects by increasing oxygen tension (PO2), raising oxygen tissue levels, decreasing intracranial pressure and relieving cerebral edema. Many of the beneficial effects of HBOT exert their protective effects at the level of the microcirculation. Furthermore, the microcirculation's exquisite pervasive presence across every tissue in the body, renders it uniquely able to influence the local environment of most tissues and organs, including the brain. As such, treatments aimed at restoring aging-induced functional and structural alterations of the cerebral microcirculation may potentially contribute to the amelioration of a range of age-related pathologies including vascular cognitive impairment, Alzheimer's disease, and vascular dementias. Despite the presented evidence, the efficacy and safety of HBOT for the treatment of age-related vascular cognitive impairment and dementia remains understudied. The present review aims to examine the existing evidence indicative of a potential therapeutic role for HBOT-induced hyperoxia against age-related cerebromicrovascular pathologies contributing to cognitive impairment, dementia and decreased healthspan in the elderly.
Collapse
Affiliation(s)
- Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jordan Delfavero
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Amber Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rafal Gulej
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
8
|
Sri Dewi Untari NK, Kusumastuti K, Suryokusumo G, Sudiana IK. Characteristics of Guillain-Barre Syndrome Patient Underwent Hyperbaric Oxygen Therapy at Lakesla 2016–2019. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Guillain-Barre syndrome (GBS) is considered an acute immune-mediated monophasic illness. Standard therapy includes intravenous immunoglobulin (IVIG) and/or plasmapheresis. Yet, long-standing disability remains a problem. In Indonesia, the availability and cost of these therapies are constraints.
AIM: To show the capability of hyperbaric oxygen (HBO2) therapy in GBS patients who did not undergo standard therapy. HBO2 also provides healing in patients who experience delays in therapy.
METHODS: Data included identity, demographic, social history, current disease history, disease progression and therapies used. Data were displayed in the form of tables and graphs.
RESULTS: Twenty-five GBS patients underwent HBO2 from 2016 to 2019. The majority of patients were males aged 20-30 years, triggered by preceding diarrhea. After approximately three to ten days following HBO2, they felt their first positive changes. They walked with assistance after two to three weeks receiving HBO2 and without assistance after four to 12 weeks receiving HBO2.
CONCLUSION: HBO2 administration show clinical improvement in GBS patients. HBO2 is expected to become an adjuctive therapy for GBS patients in Indonesia.
Collapse
|
9
|
Zhang Y, Wu J, Xiao N, Li B. Hyperbaric Oxygen Therapy Is Beneficial for the Improvement of Clinical Symptoms of Cerebral Palsy: A Systematic Review and Meta-Analysis. Complement Med Res 2021; 29:158-171. [PMID: 34569525 DOI: 10.1159/000518785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Hyperbaric oxygen (HBO) has been used for the treatment of cerebral palsy for more than 20 years, but its efficacy and safety are still controversial. In this systematic review and meta-analysis, we evaluated the currently promulgated data related to the efficacy of HBO for patients with cerebral palsy. METHODS We searched the PubMed/Medline, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases (from their inception to April 2020) for randomized controlled trials published in English or Chinese. Two researchers used the Cochrane Collaboration tool for data extraction and an independent quality assessment. The extracted data were analyzed by Review Manager 5.3 software. RESULTS A total of 25 studies consistent with the inclusion criteria were included, with a total of 2,146 people, which included 1,185 participants in the HBO group and 961 in the control group. This meta-analysis showed that when compared with the controls, HBO therapy can improve the gross motor functions evaluated by the Gross Motor Function Measure (n = 696, SMD 0.29, 95% CI [0.07-0.51], Z = 2.62, p = 0.009) and Gross Motor Function Classification System (n = 248, MD -0.40, 95% CI [-0.52 to -0.27], Z = 6.28, p < 0.00001), global developmental level evaluated by Gesell (n = 560, RR 1.30, 95% CI [1.19-1.42], Z = 6.03, p < 0.00001) and developmental quotient (n = 374, MD 8.25, 95% CI [6.48-10.01], Z = 9.15, p < 0.00001) and language expression (n = 270, MD 4.34, 95% CI [2.30-6.38], Z = 4.17, p < 0.00001) and comprehension (n = 270, MD 4.87, 95% CI [2.87-6.88], Z = 4.76, p < 0.00001). HBO therapy only caused mild ear pain. However, the quality of the data for all outcomes evaluated by the Grading of Recommendations Assessment, Development, and Evaluation analysis was very low. CONCLUSIONS HBO therapy may produce a much more efficient clinical experiment result than the control group with cerebral palsy patients, and HBO therapy is well tolerated and relatively safe for the included participants.
Collapse
Affiliation(s)
- Yingqian Zhang
- Department of Cardiology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jing Wu
- Rehabilitation Center, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Nong Xiao
- Ministry of Education Key Laboratory of Child Development and Disorders, and Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, and Rehabilitation Centre, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Bo Li
- Department of Cardiology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
10
|
Shapira R, Gdalyahu A, Gottfried I, Sasson E, Hadanny A, Efrati S, Blinder P, Ashery U. Hyperbaric oxygen therapy alleviates vascular dysfunction and amyloid burden in an Alzheimer's disease mouse model and in elderly patients. Aging (Albany NY) 2021; 13:20935-20961. [PMID: 34499614 PMCID: PMC8457592 DOI: 10.18632/aging.203485] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/10/2021] [Indexed: 04/21/2023]
Abstract
Vascular dysfunction is entwined with aging and in the pathogenesis of Alzheimer's disease (AD) and contributes to reduced cerebral blood flow (CBF) and consequently, hypoxia. Hyperbaric oxygen therapy (HBOT) is in clinical use for a wide range of medical conditions. In the current study, we exposed 5XFAD mice, a well-studied AD model that presents impaired cognitive abilities, to HBOT and then investigated the therapeutical effects using two-photon live animal imaging, behavioral tasks, and biochemical and histological analysis. HBOT increased arteriolar luminal diameter and elevated CBF, thus contributing to reduced hypoxia. Furthermore, HBOT reduced amyloid burden by reducing the volume of pre-existing plaques and attenuating the formation of new ones. This was associated with changes in amyloid precursor protein processing, elevated degradation and clearance of Aß protein and improved behavior of 5XFAD mice. Hence, our findings are consistent with the effects of HBOT being mediated partially through a persistent structural change in blood vessels that reduces brain hypoxia. Motivated by these findings, we exposed elderly patients with significant memory loss at baseline to HBOT and observed an increase in CBF and improvement in cognitive performances. This study demonstrates HBOT efficacy in hypoxia-related neurological conditions, particularly in AD and aging.
Collapse
Affiliation(s)
- Ronit Shapira
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Amos Gdalyahu
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Irit Gottfried
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Efrat Sasson
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel
| | - Shai Efrati
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Be’er Ya’akov, Israel
| | - Pablo Blinder
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
| | - Uri Ashery
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
11
|
Appropriate Treatment of Ischemic Stroke That Is Essential for the Reduction of Mortality and Morbidity: Should We Use Hyperbaric Oxygen Therapy Together With Recombinant Tissue Plasminogen Activator for Improving Brain Oxygenation and Before Recombinant Tissue Plasminogen Activator to Minimize the Risk of Massive Bleeding? Crit Care Med 2021; 49:e806-e807. [PMID: 34261938 DOI: 10.1097/ccm.0000000000004988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Li J, Meng X, Li F, Liu J, Ma M, Chen W. Huperzine A combined with hyperbaric oxygen on the effect on cognitive function and serum hypoxia-inducible factor-1α Level in elderly patients with vascular dementia. Am J Transl Res 2021; 13:6897-6904. [PMID: 34306441 PMCID: PMC8290829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the clinical effect of huperzine A combined with hyperbaric oxygen on cognitive function and serum hypoxia-inducible factor-1α (HIF-1α) level in elderly patients with vascular dementia (VD). METHODS 120 elderly VD patients admitted to our hospital from February 2018 to March 2020 were selected and divided into two groups according to the treatment method (n = 60 each). They were administered for huperzine A and huperzine A combined with hyperbaric oxygen, respectively. The comparison of disease control rate (DCR), mini-mental state examination (MMSE) score, revised hasegawa's dementia scale (HDS-R) score and serum index were conducted. RESULTS At 2 and 4 weeks after treatment, the HDS-R and MMSE scores were reported to be higher in the observation group than those in the control group (P < 0.05), and the vascular endothelial growth factor (VEGF), anti-apoptotic factor (Livin), and HIF-1α showed a higher level of improvement as compared with the control group (P < 0.05). Moreover, the DCR in the observation group was much higher than that in the control group (P < 0.05). CONCLUSION Huperzine A combined with hyperbaric oxygen is remarkably effective in the treatment of elderly VD patients. It can improve the serum HIF-1α level and speed up the recovery of cognitive function.
Collapse
Affiliation(s)
- Jiajun Li
- Guangxi University of Chinese MedicineGuangxi, China
| | - Xiangen Meng
- Department of Hyperbric Oxygen, The Sixth Medical Center of PLA General Hospital10048, China
| | - Fang Li
- Shandong Province Liaocheng Third People’s HospitalLiaocheng, China
| | - Jiamin Liu
- Guangxi University of Chinese MedicineGuangxi, China
| | - Mingyang Ma
- Guangxi University of Chinese MedicineGuangxi, China
| | - Wangkun Chen
- Encephalopathy Department, Wuxi No. 2 Chinese Medicine HospitalChina
| |
Collapse
|
13
|
Wu X, Liang TY, Wang Z, Chen G. The role of hyperbaric oxygen therapy in inflammatory bowel disease: a narrative review. Med Gas Res 2021; 11:66-71. [PMID: 33818446 PMCID: PMC8130665 DOI: 10.4103/2045-9912.311497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease is a group of chronic recurrent diseases in the digestive tract, including ulcerative colitis and Crohn's disease. Over the past few decades, the treatment of IBD has made great progress but there is still a lot of room for improvement. Hyperbaric oxygen therapy (HBOT) was defined as the therapeutic effect of inhaling 100% oxygen higher than one atmosphere and reported to be used in stroke, decompression sickness and wound healing. Since several authors reported the role of HBOT as an adjunct to conventional medical treatment in patients with refractory IBD, the relevant research has shown an increasing trend in recent years. Clinical and experimental studies have revealed that HBOT may exert its therapeutic effect by inhibiting inflammation and strengthening the antioxidant system, promoting the differentiation of colonic stem cells and recruiting cells involved in repair. The purpose of this review is to summarize the past clinical and experimental studies and to understand the impact of HBOT in the treatment of IBD more deeply. In addition, we also hope to provide some ideas for future clinical and research work.
Collapse
Affiliation(s)
- Xin Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Tian-Yu Liang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
14
|
Sen S, Sen S. Therapeutic effects of hyperbaric oxygen: integrated review. Med Gas Res 2021; 11:30-33. [PMID: 33642335 PMCID: PMC8103971 DOI: 10.4103/2045-9912.310057] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022] Open
Abstract
Hyperbaric oxygen therapy refers to inhalation of pure oxygen in a closed chamber. Hyperbaric oxygen has a therapeutic effect in numerous pathological conditions, such as decompression sickness, arterial gas embolism, carbon monoxide poisoning and smoke inhalation, osteomylitis, osteoradionecrosis and wound healing. Hyperbaric oxygen therapy is used for treating underlying hypoxia. This review indicates the action of hyperbaric oxygen on biochemical and various physiological changes in cellular level. Narrative review covers the current indications and contraindications of hyperbaric oxygen therapy. The review also focuses on the therapeutic effects of hyperbaric oxygen pretreatment and precondition in different pathological conditions. The complications and side effects of hyperbaric oxygen therapy are discussed.
Collapse
Affiliation(s)
- Suman Sen
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Sheuli Sen
- Department of Pediatric Nursing, Sumandeep Nursing College, Sumandeep University, Vadodara, Gujarat, India
| |
Collapse
|
15
|
Cevolani D, Di Donato F, Santarella L, Bertossi S, Cellerini M. Functional MRI (fMRI) Evaluation of Hyperbaric Oxygen Therapy (HBOT) Efficacy in Chronic Cerebral Stroke: A Small Retrospective Consecutive Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010190. [PMID: 33383925 PMCID: PMC7794810 DOI: 10.3390/ijerph18010190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 05/07/2023]
Abstract
Topics: Functional Magnetic Resonance Imaging (fMRI) evaluation of HyberBaric Oxygen Therapy (HBOT) effects on chronic cerebral stroke Patients (Pts). Introduction: Our aim was to evaluate with fMRI, in a 3 Tesla system, the functional effects of HBOT on the Central Nervous System (CNS) in four Pts with established ischaemic and haemorrhagic cerebral strokes (2 Pts each). To our knowledge, no author used this Magnetic Resonance (MR) technique for this purpose, till now. Methods: All four Pts underwent a fMRI study before and after 40 HBOT sessions, with a time window of a few days. They carried out two language (text listening, silent word-verb generation) and two motor (hand and foot movements) tasks (30 s On-Off block paradigms). Results: After HBOT, all Pts reported a clinical improvement, mostly concerning language fluency and motor paresis. fMRI analysis demonstrated an increase in both the extent and the statistical significance of most of the examined eloquent areas. Conclusions: These changes were consistent with the clinical improvement in all Pts, suggesting a possible role of fMRI in revealing neuronal functional correlates of neuronal plasticity and HBOT-related neoangiogenesis. Although only four Pts were examined, fMRI proved to be a sensitive, non-invasive and reliable modality for monitoring neuronal functional changes before and after HBOT.
Collapse
Affiliation(s)
- Daniela Cevolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, c/o Neuroradiology Unit, “Bellaria” Hospital, 40139 Bologna, Italy
- Correspondence: ; Tel.: +39-339-46-222-47
| | - Ferruccio Di Donato
- Hyperbaric Centre of Bologna, Quarto Inferiore, 40057 Bologna, Italy; (F.D.D.); (L.S.); (S.B.)
| | - Luigi Santarella
- Hyperbaric Centre of Bologna, Quarto Inferiore, 40057 Bologna, Italy; (F.D.D.); (L.S.); (S.B.)
| | - Simone Bertossi
- Hyperbaric Centre of Bologna, Quarto Inferiore, 40057 Bologna, Italy; (F.D.D.); (L.S.); (S.B.)
| | - Martino Cellerini
- Neuroradiology Unit, “Bellaria” Hospital, IRCCS Institute of Neurological Sciences, 40139 Bologna, Italy;
| |
Collapse
|
16
|
Cozene B, Sadanandan N, Gonzales-Portillo B, Saft M, Cho J, Park YJ, Borlongan CV. An Extra Breath of Fresh Air: Hyperbaric Oxygenation as a Stroke Therapeutic. Biomolecules 2020; 10:E1279. [PMID: 32899709 PMCID: PMC7563917 DOI: 10.3390/biom10091279] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Stroke serves as a life-threatening disease and continues to face many challenges in the development of safe and effective therapeutic options. The use of hyperbaric oxygen therapy (HBOT) demonstrates pre-clinical effectiveness for the treatment of acute ischemic stroke and reports reductions in oxidative stress, inflammation, and neural apoptosis. These pathophysiological benefits contribute to improved functional recovery. Current pre-clinical and clinical studies are testing the applications of HBOT for stroke neuroprotection, including its use as a preconditioning regimen. Mild oxidative stress may be able to prime the brain to tolerate full extensive oxidative stress that occurs during a stroke, and HBOT preconditioning has displayed efficacy in establishing such ischemic tolerance. In this review, evidence on the use of HBOT following an ischemic stroke is examined, and the potential for HBOT preconditioning as a neuroprotective strategy. Additionally, HBOT as a stem cell preconditioning is also discussed as a promising strategy, thus maximizing the use of HBOT for ischemic stroke.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Cesar V. Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (B.C.); (N.S.); (B.G.-P.); (M.S.); (J.C.); (Y.J.P.)
| |
Collapse
|
17
|
Schiavo S, Richardson D, Santa Mina D, Buryk-Iggers S, Uehling J, Carroll J, Clarke H, Djaiani C, Gershinsky M, Katznelson R. Hyperbaric oxygen and focused rehabilitation program: a feasibility study in improving upper limb motor function after stroke. Appl Physiol Nutr Metab 2020; 45:1345-1352. [PMID: 32574506 DOI: 10.1139/apnm-2020-0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Neuroplasticity and recovery after stroke can be enhanced by a rehabilitation program pertinent to upper limb motor function exercise and mental imagery (EMI) as well as hyperbaric oxygen therapy (HBOT). We assessed feasibility and safety of the combined approach utilizing both HBOT and EMI, and to derive preliminary estimates of its efficacy. In this randomized controlled trial, 27 patients with upper extremity hemiparesis at 3-48 months after stroke were randomized to receive either a complementary rehabilitation program of HBOT-EMI (intervention group), or EMI alone (control group). Feasibility and safety were assessed as total session attendance, duration of sessions, attrition rates, missing data, and intervention-related adverse events. Secondary clinical outcomes were assessed with both objective tools and self-reported measures at baseline, 8 weeks (end of treatment), and 12-weeks follow-up. Session attendance, duration, and attrition rate did not differ between the groups; there were no serious adverse events. Compared with baseline, there were significant sustained improvements of objective and subjective outcomes' measures in the intervention group, and a single improvement in an objective measure in the control group. Between-group outcome comparisons were not statistically significant. This study demonstrated that the combination HBOT-EMI was a safe and feasible approach in patients recovering from chronic stroke. There were also trends for improved motor function of the affected upper limb after the treatments. ClinicalTrials.gov registration no.: NCT02666469. Novelty HBOT combined with an upper limb exercise and mental imagery rehabilitation program is feasible and safe in chronic stroke patients. This combined approach showed trends for improved functional recovery.
Collapse
Affiliation(s)
- S Schiavo
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - D Richardson
- Stroke Rehabilitation Clinic, Toronto Rehabilitation Institute, Toronto, ON M5G 2C4, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5G 2C1, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto.,Department of Supportive Care, Princess Margaret Cancer Centre Toronto, ON M5G 2C1, Canada
| | - S Buryk-Iggers
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - J Uehling
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - J Carroll
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - H Clarke
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - C Djaiani
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - M Gershinsky
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - R Katznelson
- Hyperbaric Medicine Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| |
Collapse
|
18
|
Hyperbaric oxygen therapy in acute stroke: is it time for Justitia to open her eyes? Neurol Sci 2020; 41:1381-1390. [PMID: 31925614 DOI: 10.1007/s10072-020-04241-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/06/2020] [Indexed: 01/27/2023]
Abstract
Hypoxia is a critical component of neuronal death in patients with stroke. Therefore increasing oxygenation of brain tissue seems to be a logical therapy against cerebral ischemia. Oxygen therapy exists in two modalities: normobaric hyperoxia therapy and hyperbaric oxygen therapy (HBO). HBO is a therapeutic procedure in which pure (100%) oxygen is administered at greater than atmospheric pressure in HBO therapy chambers. In this review article, we aimed to summarize the current knowledge regarding the therapeutic use of HBO in acute stroke patients. Literature review and electronic search were performed using PubMed, Medscape, and UpToDate with the keywords stroke, acute stroke, hyperbaric oxygen therapy, and hyperoxia. According to the reviewed literature, the use of HBO as routine stroke therapy cannot be justified in acute stage of stroke. More randomized, controlled studies are needed regarding safety and especially effectives of HBO in stroke patients. Also, standardized definitionof HBO should be proposed and used in all future studies.
Collapse
|
19
|
Yang Y, Xu L, Xie R, Dang Y, Xia X, He J, Zhao J. A meta-analysis on the efficiency of the time window of hyperbaric oxygen treatment on disorders of consciousness in China. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To investigate the clinical effects of time window on hyperbaric oxygen treatment (HBOT) in patients with disorders of consciousness (DOC). Methods All the clinical research literature regarding HBOT for DOC published between January 2000 and November 2020 were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Standards Database (WFSD) and VIP Database using Chinese key words disorders of consciousness, the vegetable state, minimally conscious state, or hyperbaric oxygen followed by a comprehensive meta-analysis. Results The query gave rise to 348 results, in which 21 articles were eventually selected for meta-analysis. Among the selected 21 articles, 18 articles involved a time window comparison. All the patients were classified into < 60- (718 patients) and ≥ 60- (374 patients) day groups depending on the number of days from HBOT initiation. The Jadad scores for the included datasets were relatively low in general with 2 points as the highest score. Comparable baseline data were demonstrated in all of the articles. Datasets from different sources were pooled and analyzed, and the results suggested that the clinical curative effect rate in the treatment group was significantly higher compared with that in the control group (curative effect rate: 69.86% versus 42.30%; Z = 11.28, P = 0.000, odds ratio = 3.80, 95% CI = 3.02-4.80). Additionally, the adverse reaction rate of the < 60-day group was found to be significantly lower compared with that of the ≥ 60-day group (Z = 10.01, P = 0.000, odds ratio = 4.82, 95% CI = 3.54-6.56). The funnel diagram in articles related to curative effect analysis and time window evaluation is inverted and symmetrical, indicating that publication bias was not significant. Conclusions The clinical curative effect of the HBOT group is higher compared with that of the control group. However, the conclusions based on meta-analysis are limited because of the methodological problems of some studies. Therefore, the clinical efficacy needs to be further tested using carefully designed large sample trials (multicenter, randomized, controlled, and double-blind).
Collapse
|
20
|
Golan H, Makogon B, Volkov O, Smolyakov Y, Hadanny A, Efrati S. Imaging-based predictors for hyperbaric oxygen therapy outcome in post-stroke patients. Report 1. Med Hypotheses 2019; 136:109510. [PMID: 31846850 DOI: 10.1016/j.mehy.2019.109510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/06/2023]
Abstract
We tested the hypothesis that if SPECT/CT-detected volumes of active and inactive parts of brain tissue present correlation with the results of hyperbaric oxygen therapy (HBOT) of ischemic stroke, SPECT imaging may serve as a selective tool for post-stroke patients to indicate cases that may significantly benefit from HBOT. A retrospective analysis was conducted on 62 consecutive patients administered for HBOT after the ischemic stroke episode. All patients received 60 daily hyperbaric sessions consisting of 90 min of exposure to 100% oxygen at a pressure of 0.2 MPa. The results of the treatment were assessed in correlation with SPECT/CT-detected changes of volumes of the penumbra area around the stroke zone. Patients who significantly benefitted from HBOT (n = 24) by an improvement of their clinical neurologic status and quality of life had the large penumbra zone (363 ± 20.5 ml) that was significantly diminished during HBOT. Patients who did not benefit from HBOT (n = 20) had a relatively small volume of the penumbra zone (148 ± 29.3 ml) and its further diminishing during HBOT was insignificant. The HBOT results were unclear in 18 patients with penumbra volumes between these values. These findings support our hypothesis that the large volume of the penumbra area around the stroke zone can serve as a significant predictor for positive clinical outcome following HBOT in post-stroke patients. The SPECT/CT-based assessment procedure of the volume of the penumbra may serve as an effective selecting tool when HBOT is administered for patients with ischemic stroke.
Collapse
Affiliation(s)
- Haim Golan
- Nuclear Medicine Institute, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel.
| | - Boris Makogon
- Radiology Dept, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel
| | - Olga Volkov
- Nuclear Medicine Institute, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel
| | - Yuri Smolyakov
- Department of Medical Physics and Informatics, Chita State Medical Academy, Russia
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel; Neurosurgery Department, Galilee Medical Center, Naharyia, Israel; Galilee Faculty of Medicine, Bar Ilan University, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Beer Yaakov, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Israel
| |
Collapse
|
21
|
Gonzales-Portillo B, Lippert T, Nguyen H, Lee JY, Borlongan CV. Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury. Brain Circ 2019; 5:101-105. [PMID: 31620655 PMCID: PMC6785945 DOI: 10.4103/bc.bc_31_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Although hyperbaric oxygen therapy (HBOT) is common as a treatment for injuries, this study aimed to research the ability of HBOT in preconditioning to diminish any potential damage. The hypothesis stated that HBOT preconditioning alleviated the death of cells in primary rat neuronal cells (PRNCs) by transferring mitochondria from astrocytes. In this experiment, PRNCs were given an HBOT treatment before a tumor necrosis factor-alpha or lipopolysaccharide injury which resembled cell death associated with stroke and traumatic brain injury (TBI). After being examined, the study found more cell viability in the PRNCs that had received HBOT precondition and a mitochondrial transfer. The mitochondrial transfer was visualized by a series of images showing the transfer after the HBOT treatment. This study demonstrated the ability of HBOT preconditioning as a treatment for inflammation in stroke and TBI, with the transfer of mitochondria from astrocytes to PRNCs reducing cell death. Along with discussion of the study, this review also focuses on different stroke treatments in comparison with HBOT.
Collapse
Affiliation(s)
- Bella Gonzales-Portillo
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Trenton Lippert
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Hung Nguyen
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Jea-Young Lee
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Cesar V Borlongan
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| |
Collapse
|
22
|
Lippert T, Borlongan CV. Prophylactic treatment of hyperbaric oxygen treatment mitigates inflammatory response via mitochondria transfer. CNS Neurosci Ther 2019; 25:815-823. [PMID: 30972972 PMCID: PMC6630002 DOI: 10.1111/cns.13124] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022] Open
Abstract
Aims Hyperbaric oxygen therapy (HBOT) has been widely used as postinjury treatment; however, we investigate its ability to mitigate potential damage as a preconditioning option. Here, we tested the hypothesis that HBOT preconditioning mitigates cell death in primary rat neuronal cells (PRNCs) through the transfer of mitochondria from astrocytes. Methods Primary rat neuronal cells were subjected to a 90‐minute HBOT treatment at 2.5 absolute atmospheres prior to either tumor necrosis factor‐alpha (TNF‐alpha) or lipopolysaccharide (LPS) injury to simulate the inflammation‐plagued secondary cell death associated with stroke and traumatic brain injury (TBI). After incubation with TNF‐alpha or LPS, the cell viability of each group was examined. Results There was a significant increase of cell viability accompanied by mitochondrial transfer in the injury groups that received HBOT preconditioning compared to the injury alone groups (44 ± 5.2 vs 68 ± 4.48, n = 20, P < 0.05). The transfer of mitochondria directly after HBOT treatment was visualized by capturing images in 5‐minute intervals, which revealed that the robust transfer of mitochondria begins soon after HBOT and persisted throughout the treatment. Conclusion This study shows that HBOT preconditioning stands as a robust prophylactic treatment for sequestration of inflammation inherent in stroke and TBI, possibly facilitating the transfer of resilient mitochondria from astrocytes to inflammation‐susceptible neuronal cells in mitigating cell death.
Collapse
Affiliation(s)
- Trenton Lippert
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, USF Morsani College of Medicine, Tampa, Florida.,University of South Florida Honors College, Tampa, Florida
| | - Cesario V Borlongan
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, USF Morsani College of Medicine, Tampa, Florida
| |
Collapse
|
23
|
Abstract
Hypoxia causes a cascade of activity from the level of the individual down to the regulation and function of the cell nucleus. Prolonged periods of low oxygen tension are a core feature of several disease states. Advances in the study of molecular biology have begun to bridge the gap between the cellular response to hypoxia and physiology. Hyperbaric oxygen therapy is a treatment for hypoxic- and inflammatory-driven conditions, in which patients are treated with 100% oxygen at pressures greater than atmospheric pressure. This review discusses hypoxia, the physiologic changes associated with hypoxia, the responses that occur in the cells during hypoxic conditions, and the role that hyperbaric oxygen therapy can play as part of the treatment for many patients suffering from diseases with underlying hypoxia.
Collapse
Affiliation(s)
- Ryan Choudhury
- Department of Internal Medicine, Graduate Medical Education, St Vincent Charity Medical Center, Cleveland, OH, USA,
| |
Collapse
|
24
|
Knecht T, Borlongan C, Dela Peña I. Combination therapy for ischemic stroke: Novel approaches to lengthen therapeutic window of tissue plasminogen activator. Brain Circ 2018; 4:99-108. [PMID: 30450415 PMCID: PMC6187940 DOI: 10.4103/bc.bc_21_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
Tissue plasminogen activator (tPA) thrombolysis continues to be the gold standard therapy for ischemic stroke. Due to the time-limited treatment window, within 4.5 h of stroke onset, and a variety of potentially deadly complications related to delayed administration, particularly hemorrhagic transformation (HT), clinical use of tPA is limited. Combination therapies with other interventions, drug or nondrug, have been hypothesized as a logical approach to enhancing tPA effectiveness. Here, we discuss various potential pharmacological and nondrug treatments to minimize adverse effects, primarily HT, associated with delayed tPA administration. Pharmacological interventions include many that support the integrity of the blood–brain barrier (i.e., atorvastatin, batimastat, candesartan, cilostazol, fasudil, and minocycline), promote vascularization and preserve cerebrovasculature (i.e., coumarin derivative IMM-H004 and granulocyte-colony stimulating factor), employing other mechanisms of action (i.e., oxygen transporters and ascorbic acid). Nondrug treatments are comprised of stem cell transplantation and gas therapies with multi-faceted approaches. Combination therapy with tPA and the aforementioned treatments demonstrated promise for mitigating the adverse complications associated with delayed tPA treatment and rescuing stroke-induced behavioral deficits. Therefore, the conjunctive therapy method is a novel therapeutic approach that can attempt to minimize the limitations of tPA treatment and possibly increase the therapeutic window for ischemic stroke treatment.
Collapse
Affiliation(s)
- Talia Knecht
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| | - Cesar Borlongan
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Ike Dela Peña
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
25
|
Huang Z, Lu L, Jiang T, Zhang S, Shen Y, Zheng Z, Zhao A, Gao R, Li R, Zhou S, Liu J. miR-29b affects neurocyte apoptosis by targeting MCL-1 during cerebral ischemia/reperfusion injury. Exp Ther Med 2018; 16:3399-3404. [PMID: 30233687 PMCID: PMC6143871 DOI: 10.3892/etm.2018.6622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to determine whether an miRNA (miR)-29b inhibitor protected against cerebral ischemia/reperfusion (I/R) injury in vitro and to investigate the underlying mechanisms. As a model for induced cerebral IR injury, N2a cells were exposed to an oxygen-glucose deprivation/reoxygenation (OGD/R) environment. Using this model, it was demonstrated that miR-29b was significantly upregulated compared with cells in a normal environment. The interactions between miR-29b and myeloid cell leukemia sequence (MCL)-1 were then investigated using dual-luciferase assays, revealing a strong regulation of MCL-1 through the 3'untranslated region. Using the OGD/R model, the present study additionally examined the effects of miR-29b and miR-29b inhibitor on cell viability and apoptosis using Cell Counting kit 8 and flow cytometry assays, respectively. miR-29b transfection led to increased N2a cell apoptosis and reduced cell viability under an OGD/R environment. However, this effect was reversed by the miR-29b inhibitor. Finally, the effects of miR-29b on the expression of several Wnt-associating proteins were examined. It was observed that B cell lymphoma-2 was inhibited by miR-29b, as was MCL-1, whereas caspase-3 expression was promoted. The miR-29b inhibitor demonstrated the opposite effect. Overall, miR-29b promoted neurocyte apoptosis by targeting MCL-1 during cerebral I/R injury. The results of the present study suggest a potential novel therapeutic target for the treatment of ischemic stroke.
Collapse
Affiliation(s)
- Zhi Huang
- Department of Intervention, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China.,Department of Intervention, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Lu Lu
- Shenzhen Key Laboratory of Ophthalmoloy, Shenzhen Eye Hospital, Shenzhen, Guangdong 518040, P.R. China
| | - Tianpeng Jiang
- Department of Intervention, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Shuai Zhang
- Department of Intervention, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Yaping Shen
- Department of Intervention, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Zhu Zheng
- School of Biology and Engineering, Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Ansu Zhao
- School of Biology and Engineering, Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Rui Gao
- Guizhou Entry-Exit Inspection and Quarantine Bureau of The People's Republic of China, Guiyang, Guizhou 550002, P.R. China
| | - Rui Li
- Department of Rehabilitation, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Shi Zhou
- Department of Intervention, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China.,Department of Intervention, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Jing Liu
- Department of Intervention, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| |
Collapse
|
26
|
da Silva SC, Feres O, da Silva Beggiora P, Machado HR, Menezes-Reis R, Araújo JE, Brandão RA, da Silva Lopes L. Hyperbaric oxygen therapy reduces astrogliosis and helps to recovery brain damage in hydrocephalic young rats. Childs Nerv Syst 2018; 34:1125-1134. [PMID: 29671042 DOI: 10.1007/s00381-018-3803-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/10/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE We investigated the possible beneficial effects that hyperbaric oxygen therapy could offer in different brain structures affected by ventriculomegaly in pup rats submitted to experimental hydrocephalus. METHODS Seven-day-old Wistar rats were submitted to hydrocephalus by intracisternal injection of 10% kaolin into the cisterna magna. The animals were divided into four groups: control (n = 5); control with HBOT (3ATA/2 h/day) (n = 5); untreated hydrocephalic (n = 10); hydrocephalic treated with HBOT (3ATA/2 h/day) (n = 10). The treatment with HBOT was performed daily for 14 days post-induction of hydrocephalus. To evaluate the response to treatment, behavioral tests (open field, Morris water maze, and activity monitor) were performed. After 14 days, the animals were euthanized, and the brain was removed for histological (hematoxylin-eosin and solochrome-cyanine) and immunohistochemical (GFAP and Ki-67) studies. RESULTS The hyperbaric treatment, although not causing changes in ventricular enlargement, resulted in a significant improvement in the behavioral performance (p = 0.0001), with greater agility and exploration of the environment, preservation of spatial memory, and greater learning capacity (p = 0.0001). Through the immunohistochemical study, the astrocytic activity (glial fibrillary acidic protein) in the corpus callosum (p = 0.0001) and in the germinative matrix (p = 0.0033) was significantly reduced as compared to that in the H group. CONCLUSION The results suggest that hyperbaric treatment bettered the behavioral performance and offered benefits to the structures affected by the ventricular increase helping to recover the brain damages. In this way, the HBOT it can be considered an adjuvant therapy for the treatment of hydrocephalus.
Collapse
Affiliation(s)
- Stephanya Covas da Silva
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil.
| | - Omar Feres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil
| | - Pâmella da Silva Beggiora
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil
| | - Hélio Rubens Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil
| | - Rafael Menezes-Reis
- Department of Biomechanics, Medicine and Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, 3900 Av. dos Bandeirantes, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - João Eduardo Araújo
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, 3900 Av. dos Bandeirantes, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Ricardo Andrade Brandão
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil
| | - Luiza da Silva Lopes
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo - USP, Bandeirantes Av., 3900, Ribeirão Preto, São Paulo, 14049-090, Brazil
| |
Collapse
|
27
|
Liska GM, Lippert T, Russo E, Nieves N, Borlongan CV. A Dual Role for Hyperbaric Oxygen in Stroke Neuroprotection: Preconditioning of the Brain and Stem Cells. CONDITIONING MEDICINE 2018; 1:151-166. [PMID: 30079404 PMCID: PMC6075658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Stroke continues to be an extremely prevalent disease and poses a great challenge in developing safe and effective therapeutic options. Hyperbaric oxygen therapy (HBOT) has demonstrated significant pre-clinical effectiveness for the treatment of acute ischemic stroke, and limited potential in treating chronic neurological deficits. Reported benefits include reductions in oxidative stress, inflammation, neural apoptosis, and improved physiological metrics such as edema and oxygen perfusion, all of which contribute to improved functional recovery. This pre-clinical evidence has failed to translate into an effective evidence-based therapy, however, due in large part to significant inconsistencies in treatment protocols and design of clinical studies. While the medical community works to standardize clinical protocols in an effort to advance HBOT for acute stroke, pre-clinical investigations continue to probe novel applications of HBOT in an effort to optimize stroke neuroprotection. One such promising strategy is HBOT preconditioning. Based upon the premise of mild oxidative stress priming the brain for tolerating the full-blown oxidative stress inherent in stroke, HBOT preconditioning has displayed extensive efficacy. Here, we first review the pre-clinical and clinical evidence supporting HBOT delivery following ischemic stroke and then discuss the scientific basis for HBOT preconditioning as a neuroprotective strategy. Finally, we propose the innovative concept of stem cell preconditioning, in tandem with brain preconditioning, as a promising regenerative pathway for maximizing the application of HBOT for ischemic stroke treatment.
Collapse
Affiliation(s)
| | | | | | | | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL
| |
Collapse
|
28
|
Zhou Z, Lu J, Liu WW, Manaenko A, Hou X, Mei Q, Huang JL, Tang J, Zhang JH, Yao H, Hu Q. Advances in stroke pharmacology. Pharmacol Ther 2018; 191:23-42. [PMID: 29807056 DOI: 10.1016/j.pharmthera.2018.05.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Stroke occurs when a cerebral blood vessel is blocked or ruptured, and it is the major cause of death and adult disability worldwide. Various pharmacological agents have been developed for the treatment of stroke either through interrupting the molecular pathways leading to neuronal death or enhancing neuronal survival and regeneration. Except for rtPA, few of these agents have succeeded in clinical trials. Recently, with the understanding of the pathophysiological process of stroke, there is a resurrection of research on developing neuroprotective agents for stroke treatment, and novel molecular targets for neuroprotection and neurorestoration have been discovered to predict or offer clinical benefits. Here we review the latest major progress of pharmacological studies in stroke, especially in ischemic stroke; summarize emerging potential therapeutic mechanisms; and highlight recent clinical trials. The aim of this review is to provide a panorama of pharmacological interventions for stroke and bridge basic and translational research to guide the clinical management of stroke therapy.
Collapse
Affiliation(s)
- Zhenhua Zhou
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA; Department of Neurology, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jianfei Lu
- Discipline of Neuroscience, Department of Physiology and Anatomy, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wen-Wu Liu
- Department of Diving and Hyperbaric Medicine, the Second Military Medical University, Shanghai 200433, China
| | - Anatol Manaenko
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Xianhua Hou
- Department of Neurology, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Qiyong Mei
- Department of Neurosurgery, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China
| | - Jun-Long Huang
- Discipline of Neuroscience, Department of Physiology and Anatomy, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiping Tang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Honghong Yao
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing, China.
| | - Qin Hu
- Discipline of Neuroscience, Department of Physiology and Anatomy, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| |
Collapse
|
29
|
Hentia C, Rizzato A, Camporesi E, Yang Z, Muntean DM, Săndesc D, Bosco G. An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning. Brain Behav 2018; 8:e00959. [PMID: 29761012 PMCID: PMC5943756 DOI: 10.1002/brb3.959] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Ischemia/reperfusion (I/R) injury, such as myocardial infarction, stroke, and peripheral vascular disease, has been recognized as the most frequent causes of devastating disorders and death currently. Protective effect of various preconditioning stimuli, including hyperbaric oxygen (HBO), has been proposed in the management of I/R. METHODS In this study, we searched and reviewed up-to-date published papers to explore the pathophysiology of I/R injury and to understand the mechanisms underlying the protective effect of HBO as conditioning strategy. RESULTS Animal study and clinic observation support the notion that HBO therapy and conditioning provide beneficial effect against the deleterious effects of postischemic reperfusion. Several explanations have been proposed. The first likely mechanism may be that HBO counteracts hypoxia and reduces I/R injury by improving oxygen delivery to an area with diminished blood flow. Secondly, by reducing hypoxia-ischemia, HBO reduces all the pathological events as a consequence of hypoxia, including tissue edema, increased affective area permeability, postischemia derangement of tissue metabolism, and inflammation. Thirdly, HBO may directly affect cell apoptosis, signal transduction, and gene expression in those that are sensitive to oxygen or hypoxia. HBO provides a reservoir of oxygen at cellular level not only carried by blood, but also by diffusion from the interstitial tissue where it reaches high concentration that may last for several hours, improves endothelial function and rheology, and decreases local inflammation and edema. CONCLUSION Evidence suggests the benefits of HBO when used as a preconditioning stimulus in the setting of I/R injury. Translating the beneficial effects of HBO into current practice requires, as for the "conditioning strategies", a thorough consideration of risk factors, comorbidities, and comedications that could interfere with HBO-related protection.
Collapse
Affiliation(s)
- Ciprian Hentia
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy.,Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Alex Rizzato
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy
| | | | - Zhongjin Yang
- The Institute for Human Performance SUNY Upstate Medical University Syracuse NY USA
| | - Danina M Muntean
- Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania.,Center for Translational Research and Systems Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Dorel Săndesc
- Faculty of Medicine "Victor Babeș" University of Medicine and Pharmacy Timișoara Romania
| | - Gerardo Bosco
- Master II level in Hyperbaric Medicine Department of Biomedical Sciences University of Padova Padova Italy
| |
Collapse
|
30
|
Adjunctive Therapy Approaches for Ischemic Stroke: Innovations to Expand Time Window of Treatment. Int J Mol Sci 2017; 18:ijms18122756. [PMID: 29257093 PMCID: PMC5751355 DOI: 10.3390/ijms18122756] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 12/18/2022] Open
Abstract
Tissue plasminogen activator (tPA) thrombolysis remains the gold standard treatment for ischemic stroke. A time-constrained therapeutic window, with the drug to be given within 4.5 h after stroke onset, and lethal side effects associated with delayed treatment, most notably hemorrhagic transformation (HT), limit the clinical use of tPA. Co-administering tPA with other agents, including drug or non-drug interventions, has been proposed as a practical strategy to address the limitations of tPA. Here, we discuss the pharmacological and non-drug approaches that were examined to mitigate the complications-especially HT-associated with delayed tPA treatment. The pharmacological treatments include those that preserve the blood-brain barrier (e.g., atovarstatin, batimastat, candesartan, cilostazol, fasudil, minocycline, etc.), enhance vascularization and protect the cerebrovasculature (e.g., coumarin derivate IMM-H004 and granulocyte-colony stimulating factor (G-CSF)), and exert their effects through other modes of action (e.g., oxygen transporters, ascorbic acid, etc.). The non-drug approaches include stem cell treatments and gas therapy with multi-pronged biological effects. Co-administering tPA with the abovementioned therapies showed promise in attenuating delayed tPA-induced side effects and stroke-induced neurological and behavioral deficits. Thus, adjunctive treatment approach is an innovative therapeutic modality that can address the limitations of tPA treatment and potentially expand the time window for ischemic stroke therapy.
Collapse
|
31
|
Liu Y, Li Y, Ren Z, Si W, Li Y, Wei G, Zhao W, Zhou J, Tian Y, Chen D. MicroRNA-125a-3p is involved in early behavioral disorders in stroke-afflicted rats through the regulation of Cadm2. Int J Mol Med 2017; 40:1851-1859. [PMID: 29039453 PMCID: PMC5716446 DOI: 10.3892/ijmm.2017.3179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/06/2017] [Indexed: 12/25/2022] Open
Abstract
Ischemic strokes carry a significant risk of mortality and recurrent vascular events. Recent studies suggest that changes in microRNAs (miRNAs or miRs) may affect the development of the stroke. However, few studies have investigated the role of miRNAs in behavioral disorder in early stroke. In the present study, animal models of middle cerebral artery occlusion (MCAO) are used, as well as a cell model of neurite outgrowth to further investigate the role of miRNAs in targeting synapse-associated proteins expression in early stroke. The authors used miRNA expression microarrays on RNA extracted from the cortex tissue samples from the rats of MCAO and control rats. Reverse transcription-quantitative polymerase chain reaction was conducted to verify the candidate miRNAs discovered by microarray analysis. Data indicated that miR-125a was significantly increased in the cortex of the model of MCAO, which were concomitant with that rats of MCAO at the same age displayed significant behavioral deficits. Bioinformatics analysis predicted the cell adhesion molecule 2 (Cadm2, mRNA) neurite outgrowth-associated protein is targeted by miR-125a. Overexpression of miR-125a reduced the level of Cadm2 expression in PC12 cell injury induced by free-serum. In contrast, inhibition of miR-125a using miR-125a inhibitors significantly resulted in higher levels of Cadm2 expression. In conclusion, miR-125a is involved in the behavioral disorder of animal models of MCAO by regulation of Cadm2.
Collapse
Affiliation(s)
- Yuqing Liu
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yunjun Li
- Center of Sanxi Community Health Service, Shenzhen Dapeng District Maternal and Child Health Care Hospital, Shenzhen, Guangdong 518120, P.R. China
| | - Zhenxing Ren
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Wenwen Si
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yiwei Li
- School of Nursing, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Gang Wei
- Research and Development of New Drugs, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Wenguang Zhao
- School of Medical Information Engineering, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Jianhong Zhou
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yage Tian
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Dongfeng Chen
- Department of Anatomy, The Research Center of Integrative Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| |
Collapse
|
32
|
Wu Y, Hu L, Yang X, Wang X, Wan L, Hua X, Cheng J, Li Y. Intraluminal spindle-shaped-head suture induced occlusion of middle cerebral artery in the rats. Neurol Res 2017; 39:1028-1036. [PMID: 28936922 DOI: 10.1080/01616412.2017.1375661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to introduce a modified animal model of middle cerebral arterial occlusion (MCAO) through placement of intraluminal spindle-shaped head suture by comparing the traditional MCAO model. METHODS A total of 60 male Spraque-Dawley (SD) rats were divided into two groups and MCAO was induced using spindle-shaped head suture or round head suture. The mortality, infarct volume, neurological function, success rate of the surgery, and stability of modeling were examined to evaluate the effectiveness of this model. RESULTS Our results showed the success rate was 90.0% in spindle-shaped head group and 83.3% in round head group showing no significant difference; spindle-shaped head achieved a better establishment of MCAO model as shown in neurological examination. The infarct volume was 31.99 ± 5.44% in spindle-shaped head group and was significantly higher than in round head group (24.59 ± 7.17%; p < 0.05), and the coefficient of variation of infarct volume in spindle-shaped head group was lower than in round head group. CONCLUSION Our findings indicate that the modified suture induces a more reproducible and stable ischemic stroke following MCAO in SD rats.
Collapse
Affiliation(s)
- Ye Wu
- a Department of Neurosurgery , Tongde Hospital of Zhejiang Province , Hangzhou , China
| | - Lan Hu
- b Department of Neurology , The First People's Hospital of Wujiang , Suzhou , China
| | - Xiaosheng Yang
- c Department of Neurosurgery , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xuhui Wang
- c Department of Neurosurgery , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Liang Wan
- c Department of Neurosurgery , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xuming Hua
- c Department of Neurosurgery , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Juan Cheng
- d Department of Ultrasound , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yi Li
- c Department of Neurosurgery , Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| |
Collapse
|
33
|
Wang Z, Zhou F, Dou Y, Tian X, Liu C, Li H, Shen H, Chen G. Melatonin Alleviates Intracerebral Hemorrhage-Induced Secondary Brain Injury in Rats via Suppressing Apoptosis, Inflammation, Oxidative Stress, DNA Damage, and Mitochondria Injury. Transl Stroke Res 2017; 9:74-91. [PMID: 28766251 PMCID: PMC5750335 DOI: 10.1007/s12975-017-0559-x] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 12/12/2022]
Abstract
Intracerebral hemorrhage (ICH) is a cerebrovascular disease with high mortality and morbidity, and the effective treatment is still lacking. We designed this study to investigate the therapeutic effects and mechanisms of melatonin on the secondary brain injury (SBI) after ICH. An in vivo ICH model was induced via autologous whole blood injection into the right basal ganglia in Sprague-Dawley (SD) rats. Primary rat cortical neurons were treated with oxygen hemoglobin (OxyHb) as an in vitro ICH model. The results of the in vivo study showed that melatonin alleviated severe brain edema and behavior disorders induced by ICH. Indicators of blood-brain barrier (BBB) integrity, DNA damage, inflammation, oxidative stress, apoptosis, and mitochondria damage showed a significant increase after ICH, while melatonin reduced their levels. Meanwhile, melatonin promoted further increasing of expression levels of antioxidant indicators induced by ICH. Microscopically, TUNEL and Nissl staining showed that melatonin reduced the numbers of ICH-induced apoptotic cells. Inflammation and DNA damage indicators exhibited an identical pattern compared to those above. Additionally, the in vitro study demonstrated that melatonin reduced the apoptotic neurons induced by OxyHb and protected the mitochondrial membrane potential. Collectively, our investigation showed that melatonin ameliorated ICH-induced SBI by impacting apoptosis, inflammation, oxidative stress, DNA damage, brain edema, and BBB damage and reducing mitochondrial membrane permeability transition pore opening, and melatonin may be a potential therapeutic agent of ICH.
Collapse
Affiliation(s)
- Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Feng Zhou
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Yang Dou
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Xiaodi Tian
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Chenglin Liu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province, 215006, China.
| |
Collapse
|
34
|
Yang ZS, Mu J. Co-administration of tissue plasminogen activator and hyperbaric oxygen in ischemic stroke: a continued promise for neuroprotection. Med Gas Res 2017; 7:68-73. [PMID: 28480034 PMCID: PMC5402349 DOI: 10.4103/2045-9912.202912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intravenous recombinant tissue-type plasminogen activator (r-tPA, alteplase) remains the recommended therapy for acute ischemic stroke. However, several factors are limiting its practical use. It makes it urgent for us to search more efficient strategies that can save the ischemic neurons, and safely extend the time window, while in the mean time reducing the detrimental effects for stroke thrombolysis. Hyperbaric oxygen therapy (HBOT) is considered to be potentially neuroprotective. Co-administration of r-tPA and HBOT has already been proved to be effective, safe and feasible in myocardial infarction. In this article, we would like to review whether HBOT has any beneficial effects on r-tPA thrombolysis. If there is, what is the underlying possible mechanisms and how to optimize for maximal effects?
Collapse
Affiliation(s)
- Ze-Song Yang
- Department of Hematology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Mu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
35
|
Abstract
The presence of a salvageable penumbra, a region of ischemic brain tissue with sufficient energy for short-term survival, has been widely agreed as the premise for thrombolytic therapy with tissue plasminogen activator (tPA), which remains the only United States Food and Drug Administration (FDA) approved treatment for acute ischemia stroke. However, the use of tPA has been profoundly constrained due to its narrow therapeutic time window and the increased risk of potentially deadly hemorrhagic transformation (HT). Blood brain barrier (BBB) damage within the thrombolytic time window is an indicator for tPA-induced HT and both normobaric hyperoxia (NBO) and hypothermia have been shown to protect the BBB from ischemia/reperfusion injury. Therefore, providing the O2 as soon as possible (NBO treatment), freezing the brain (hypothermia treatment) to slow down ischemia-induced BBB damage or their combined use may extend the time window for the treatment of tPA. In this review, we summarize the protective effects of NBO, hypothermia or their use combined with tPA on ischemia stroke, based on which, the combination of NBO and hypothermia may be an ideal early stroke treatment to preserve the ischemic penumbra. Given this, there is an urge for large randomized controlled trials to address the effect.
Collapse
Affiliation(s)
- Wen-Cao Liu
- Department of Emergency, Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China
| | - Xin-Chun Jin
- Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases and Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
36
|
Abstract
In recent years, hyperbaric oxygen (HBO) has been used in the treatment of a lot of diseases such as decompression sickness, arterial gas embolism, carbon dioxide poisoning, soft tissue infection, refractory osteomyelitis, and problematic wound, but little is known about its application in liver transplantation. Although several studies have been conducted to investigate the protective effects of HBO on liver transplantation and liver preservation, there are still some controversies on this issue, especially its immunomodulatory effect. In this short review, we briefly summarize the findings supporting the application of HBO during liver transplantation (including donors and recipients).
Collapse
Affiliation(s)
- Hu Lv
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Cui-Hong Han
- Department of Pathology, the First Hospital of Jining City, Jining, Shandong Province, China
| | - Xue-Jun Sun
- Department of Diving and Hyperbaric Medicine, Secondary Military Medical University, Shanghai, China
| | - Wen-Wu Liu
- Department of Diving and Hyperbaric Medicine, Secondary Military Medical University, Shanghai, China
| |
Collapse
|